Los Angeles Times Features Commentary by Senior Fellow Conrad F. Meier

May 21, 2004
Conrad F. Meier

Editor's note: The following commentary by Conrad F. Meier, managing editor of Health Care News, was published by the Los Angeles Times on May 21. It also appears in the June issue of Health Care News.


No Insurance Doesn't Mean No Health Care

Misinformation disguised as a public service ad confuses the issue

The first thing I need in the morning is my favorite blend of Starbucks coffee in my "grande" cup. The last thing I need is a tasteless blend of misinformation served up grande by Starbucks and disguised as a "public service" announcement.

If you missed the full-page ads in the May 5 issue of USA Today and other newspapers around the country promoting "Cover the Uninsured Week," you missed a classic example of Orwellian newspeak.

This is not to say our healthcare finance system is perfect. It isn't. But the solutions embedded in this project suggest more government involvement rather than less, and ignore the rapidly growing trend away from bureaucratic healthcare and toward consumer-directed care.

"Cover the Uninsured Week" is another product from the Robert Wood Johnson Foundation, the advocacy group that has done so much to confuse and cripple the healthcare reform movement.

This year's lead spokesman, Noah Wyle, the actor who plays Dr. Carter on the TV drama "ER," recites in the ad the questionable data supplied by the foundation claiming that "nearly 44 million Americans go without healthcare coverage of any kind."

Wyle refers to his TV scripts as if they were fact, saying, "I've spent the last decade playing the role of a doctor on a program that depicts the plight of uninsured people who arrive in a Chicago emergency room, seeking medical care they can find nowhere else."

Make-believe is rarely a reliable guide for making real-world public policy.

According to the nonpartisan Congressional Budget Office, the uninsured figure most often cited in news media reports and television series is inflated by counting people who are uninsured only temporarily. According to the budget office, roughly 25 million Americans go without health insurance for 12 months or more.

A sizable part of the increase in the number of uninsured people in recent years is the result of illegal immigration. Roughly 9 million documented and undocumented aliens are generally included in the uninsured estimates, according to the budget office. Many hesitate to participate in a government program that could establish a paper trail for immigration authorities.

Cultural mores, folkways and language barriers also conspire to keep these people uninsured.

We are a far cry from being in a crisis. Data from three federally sponsored national surveys-- the Survey of Income and Program Participation, the Medical Expenditure Panel Survey and the National Health Interview Survey--show the number of uninsured at a particular point in time. All three surveys conclude that at any given time during a year, "uninsurance" is a much smaller problem than we are led to believe. For example, only about 30% of nonelderly people who become uninsured in a given year remain uninsured for more than 12 months. Nearly 50% regain health insurance within four months.

In other words, even the Congressional Budget Office estimate is too high by nearly half. Although 44 million Americans might be without insurance for at least a day, only somewhere in the neighborhood of 20 million are uninsured for four months or less. That's still too many uninsured, but it's a far cry from the crisis we are led to believe exists.

Population surveys are prone to reporting errors and statistical errors, making data derived from them inherently unreliable. Even when populations are properly surveyed, their answers may not be accurate.

The fact is the uninsured have access to care. The Robert Wood Johnson Foundation, however, would have us believe that being without health insurance is the same as being without healthcare "of any kind."

It might as well tell us that being without car insurance means we are without transportation. Just as there are many ways to get around that don't require insuring an automobile, so too is there public access to medical care without health insurance.

Public and private hospitals, community health centers, local health departments, free clinics, faith- based programs, emergency rooms and Veterans Affairs hospitals provide billions of dollars' worth of free care to the uninsured every year. Private and public caregivers provide billions of dollars a year more in services to uninsured patients who pay cash for care, a growing trend.

Starbucks somehow got snookered into sponsoring this year's "Cover the Uninsured Week." It's time for it to wake up and smell the coffee.


Conrad F. Meier is managing editor of Health Care News and a senior fellow at the Heartland Institute, a public policy organization based in Chicago. If you want other stories on this topic, search the Archives at latimes.com/archives.

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